CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Atrium Health Navicent Rehabilitation Hopsital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $47
Cash Discount Price: $65
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Atrium Health Navicent Rehabilitation Hopsital is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $65. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.34x the Medicare baseline. Located in 3351 Northside Dr, Macon, GA.

Cash / Self-Pay

$65

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $65 (185%)

Insurance Median: $47 (134%)

Cash: $65 (185% of Medicare)

Ins. Median: $47 (134% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$32 - $89	91%
Blue Cross Blue Shield	$32 - $61	91%
Georgia Health Advantage	$32	91%
Humana	$32 - $89	91%
Pruitt Health	$32 - $34	91%
UnitedHealthcare	$32 - $611	91%
Care Source	$33	94%
Clover	$33	94%
Eon Health	$33	94%
Alliant	$39 - $57	111%
Ambetter / Centene	$39 - $66	111%
Cigna	$39 - $266	111%
Ibg	$45 - $91	128%
Securehealth	$45 - $50	128%
Kaiser	$52 - $84	148%
Multiplan	$84 - $103	240%
Novanet	$103	294%
Three Rivers Provider Network	$110	314%
Beechstreet	$120	342%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $65.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Atrium Health Navicent Rehabilitation Hopsital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97530.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.